Abdominal tuberculosis in Bradford, UK: 1992-2002

Introduction Bradford, in West Yorkshire, United Kingdom, has a population of 486340 of which 17.3% originate from South Asia. We describe our experience of abdominal tuberculosis over a 10 year period. Methods Fifty-nine cases of abdominal tuberculosis were identified between 1992 and 2002 from the Tuberculosis Registry, Bradford hospitals. Fifty case records were available for retrospective review. Results Median age of the patients was 38 years (range, 14-81) and 35 (59.3%) were females. Fifty-four (91.5%) patients were of South Asian origin, four (6.8%) were Caucasians and one patient was an Arab. The mean standardized incidence of abdominal tuberculosis in the South Asian population during the study period was 9.32 cases/10(5)/year whereas in the local white population it was 0.1/10(5)/year (relative risk = 93). Fever (90%), abdominal pain (88%) and weight loss (82%) were the commonest presenting features. Ileocaecal region in 20 (40%) patients and tubercular peritonitis in 16 (32%) cases were the common sites involved. Active pulmonary tuberculosis was present in 18 (36%) patients. Diagnosis of tuberculosis was confirmed by isolating acid-fast bacilli or by demonstrating caseating granulomas on biopsy in 36 (72%) cases. Acid-fast bacilli isolated in all the 29 (58%) cases were Mycobacterium tuberculosis and were sensitive to all standard anti-tubercular drugs except one patient who was resistant to isoniazid. Conclusion Abdominal tuberculosis remains a common problem in a multicultural community in the United Kingdom with a varied presentation. High index of suspicion is required for early diagnosis. Most of the patients respond very well to standard anti-tubercular therapy and surgery is required only in a minority of cases. Drug resistant abdominal tuberculosis has not been a problem in this series.